Laparoscopic pomeroy tubal ligation: a comparison with tubal cauterization in a teaching hospital.

OBJECTIVE: To compare laparoscopic Pomeroy tubal ligation to standard bipolar tubal cauterization for the outcome measures of failure rate, complication rate and procedure duration, with an analysis of the effect of resident experience on procedure duration.

STUDY DESIGN: Retrospective study of patients presenting for interval sterilization between August 1998 and June 2000.

RESULTS: The characteristics of the laparoscopic Pomeroy (n = 99) and bipolar cautery (n = 62) patients were comparable. The mean procedure duration was 40.8 +/- 14.6 minutes for laparoscopic Pomeroy and 39.6 +/- 18.8 minutes for bipolar cautery (p < 0.68). Multiple regression analysis revealed that procedure duration was a function of both months in residency (R2 = .098, p < 0.007) and number of laparoscopic Pomeroy procedures performed (R2 = .082, p < 0.01). One complication occurred with each procedure (p < 0.576). Two sterilization failures occurred after bipolar cautery and 1 after laparoscopic Pomeroy (p < 0.33). The laparoscopic Pomeroy failure occurred in the shortest tubal segment obtained, 0.7 cm, versus the average segment length, 2.07 +/- .79 cm.

CONCLUSION: Laparoscopic Pomeroy did not differ from bipolar cautery for the outcome measures studied. Both time in residency and procedure-specific experience affect the duration of laparoscopic Pomeroy. A tubal segment length of 1 cm should be removed to limit sterilization failures.